What question did this study set out to answer?

This case aims to highlight the rare incidence of coinfection leading to prosthetic valve endocarditis and the challenges in treatment.

May 20, 2026

B50-36 A Case of Cardiogenic Shock Secondary to Mycobacterium Abscessus and Candida Parapsilosis Complex Bioprosthetic Heart Valve Infective Endocarditis

Key Points

This case aims to highlight the rare incidence of coinfection leading to prosthetic valve endocarditis and the challenges in treatment.
A female in her 20s with a history of intravenous drug use was treated after presenting with symptoms of infective endocarditis.
Blood and valve cultures identified M. abscessus and C. parapsilosis, prompting surgical evaluation and treatment adjustments.
Patient underwent emergent bioprosthetic valve replacement due to rapid decompensation and was treated with a multi-drug regimen.
The patient developed recurrent infective endocarditis following initial clearance of pathogens, leading to ineligibility for further surgery.
Culture results confirmed the presence of both pathogens, indicating a severe and challenging infection due to multidrug resistance.
Treatment regimens included therapies with limited standardized duration, highlighting the need for tailored approaches in such cases.

Abstract

Abstract Prosthetic valve endocarditis (PVE) due to Mycobacteroides abscessus and Candida parapsilosis coinfection in the setting of intravenous drug use (IVDU) is rare and clinically challenging. Amid rising rates of infective endocarditis (IE) associated with the opioid epidemic, we present this case to enhance understanding of these pathogens and highlight the need for standardized guidelines in persons who inject drugs. A female in her 20s with hepatitis C, polysubstance use, and prior IE from methicillin-resistant Staphylococcus aureus and Candida spp status post six weeks of antibiotics, tricuspid valve replacement with a bioprosthetic valve (BV) presented for positive surveillance blood cultures, productive cough and fevers after return to IVDU. She was empirically treated with nafcillin and amphotericin B. Imaging indicated BV destruction, prompting transfer to our facility for surgical evaluation. Repeat echocardiogram revealed BV dehiscence with ruptured chordae tendineae. She rapidly decompensated into cardiogenic shock, requiring emergent open BV replacement. Blood and valve cultures grew C. parapsilosis complex and rapidly growing mycobacterium (RGM), later speciated as M. abscessus complex. She was treated with six weeks of imipenem/cilastatin, amikacin, and amphotericin B, later transitioned to micafungin. Despite initial clearance, she developed recurrent IE deemed ineligible for surgery and was lost to follow-up. M. abscessus complex (MABSC) is a multidrug-resistant RGM increasingly identified as a rare cause of PVE with high morbidity. While MALDI-TOF aids in identification, gene sequencing is required for subspeciation and resistance profiling, particularly to macrolides, ethambutol, and fluoroquinolones. Treatment is challenging due to widespread resistance; typical regimens include amikacin, imipenem/cilastatin, linezolid, and tigecycline. Duration is not standardized, but typically exceeds six weeks, particularly in nonsurgical candidates. Cases diagnosed more than six months after valve implantation may be treated medically. Novel therapies, including bacteriophage therapy and epetraborole, are under investigation. Our case underscores the importance of early recognition, multidisciplinary care, and standardized treatment guidelines for MABSC PVE. This abstract is funded by: none

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Cite This Study

Rampal et al. (Fri,) studied this question.

synapsesocial.com/papers/6a0d5064f03e14405aa9c27d https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.5050

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